Book review: Asylum by Greg Ralls

Asylum, the second memoir by the Australian engineer, husband, author, father, and recipient of a schizophrenia diagnosis, Greg Ralls, advertises itself as the story of his detention in an UK immigration removal centre.

This event does indeed form a key part of the book and the author makes some important points about the problems of the UK detention system that deserve attention. However, for me, this is not primarily what the book is about, and so is not what I will focus on here.

For me, this book is about psychosis. More specifically, it is about the experience, triggers, consequences and treatment of delusions.

Broadly speaking, delusions can be defined as implausible, unfounded, and strongly held beliefs that are not shared by others and which are distressing and preoccupying (Freeman, 2007).

Ralls recounts experiences of both grandiose delusions and persecutory delusions (i.e., believing that harm is occurring, or is going to occur, to him and that the persecutor has the intention to cause harm; Freeman, 2007). He shows the problems both can lead to, but it is persecutory delusions that dominate the story.

Ralls does an excellent job of bringing the reader inside these delusions. He effectively communicates the panic and terror they can cause and the problematic behaviours that can stem from this.

He shows links between his delusions and wider society; a society in which job security can be precarious and in which systems for dealing with vulnerable people, such as asylum seekers, can be traumatising.

Ralls writes well, employing nice turns of phrase and rhythmic prose, making this compact book readable in a single sitting.

Two things really stood out for me. The first is Ralls’ independence of thought. He strives to provide both sides of arguments, and then reflects on what rings true to him.

The only horse Ralls has in the race between traditional psychiatry and alternative approaches (such as the Hearing Voices Movement) is himself. He is pragmatic, not ideological. He explains what approaches have helped him. He is not trying to say that the route he followed will be the best for everyone.

Because I did not feel I was being preached at or sold to, I naturally felt drawn closer into the story.

Find out more about the Hearing Voices Movement here

For example, when Ralls describes his encounters with the Hearing Voices Movement, he does not offer a simplistic wholesale endorsement or condemnation of this approach.

Instead, he describes what parts of this approach did and did not work for him (and others). For example, he feels a downside of the Hearing Voices Movement is that it encouraged him to adopt a view of voice-hearing that was incongruent with his reality:

“I took the romantic view that voice-hearing is desirable; and that coming completely off medication and hearing voices is preferable to being on medication. Nothing, for me, I’ve since found, could be further from the truth”.

And yet, he acknowledges this approach has been helpful for others and describes being able to use what he had learnt from the Hearing Voices Movement to help a fellow detainee. In the latter case, what he had learnt from the Movement enabled him to normalise voice-hearing for his fellow detainee and to allow him to try and help the detainee change the balance of power with his voices.

Similarly, when it comes to medication, Ralls reports finding it helpful. Yet, he is also clear about its potential detrimental effects, particularly on physical health. As he puts it “I’d reached a point where each fix compounded things, distressingly cascading to create one new physical problem after another”.

The second thing that stood out for me was Ralls’ willingness to describe events that do not place him in a positive light, thereby giving an honest account of the effects of delusions in his case. He shows how paranoid beliefs can lead to behaviours which are extremely hurtful to others, both emotionally and physically. He does not sugar coat psychosis. He pulls back veils rather than hiding behind them.

Delusions, Ralls states “can be downright dangerous”. For example, as a result of one of his delusions he strikes a male immigration officer more than twenty times in the head, breaking his own hand in the process.

But, perhaps most painfully, Ralls shows how delusions can lead to an inability to see beyond oneself. Given persecutory delusions, in a sense, put one into survival mode, this is to be expected. He shows how delusions can encourage an egocentricity that results in harm to a range of others.

One cannot fully imagine the worry that Ralls’ family went through as his delusions led him to travel alone to the other side of the world and remain locked up in an immigration detention centre. A helpful addition to this book would to have been to intersperse it with thoughts from his family and friends, to show the wider impact of delusions, as well as how others understand (or fail to understand) what the person is going through.

At the end of the book, Ralls reflects on what he has learned. He concludes that the true price of freedom is that “to secure our own freedom, we must deny it to others” and that “we, those who denied it to them, were responsible for their fate”.

I would recommend this book to any professional who is likely to encounter people troubled by delusions, to people going through psychosis themselves, as well as their family and friends, and indeed to anyone who wants to get a better sense of what psychosis can be like.

Ralls’ story is, as he makes clear, only one person’s story. To fully understand psychosis we need to hear a wide range of people’s perspectives and experiences. For example, some may find delusions to be coping mechanisms, born out of experiences of powerlessness, victimisation, and exploitation, best worked through by understanding the links between these experiences using tools such as the Maastricht Interview for Paranoia (Escher, Bullimore, & Romme, 2004).

Nevertheless, the world only changes one story at a time, and Ralls’ book is a welcome contribution to better understanding these experiences.